Urological Supplies Targeted Probe and Educate Review Updates: October - December 2018

The Jurisdiction D, DME MAC, Medical Review Department is conducting a Targeted Probe and Educate (TPE) review of HCPCS code(s) A4351, A4353 and A4358. The quarterly edit effectiveness results from October – December 2018 are as follows:

Based on dollars, the overall claim potential improper payment rate is 27%.

Top Denial Reasons

  • Documentation was not received in response to the Additional Documentation Request (ADR) letter.
  • Documentation does not support coverage criteria.
  • Documentation received does not support medical necessity for the item requested.
  • Claim is billed for greater quantity than the Detailed Written Order (DWO) indicates.

For complete detail see, Urological Supplies Quarterly Results of Targeted Probe and Educate Review.

Last Updated Mar 05, 2019